| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,265 |
1,238 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,925 |
1,873 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
1,306 |
1,276 |
$8K |
| D0272 |
Bitewings - two radiographic images |
639 |
621 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
680 |
656 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
508 |
488 |
$2K |
| D0274 |
Bitewings - four radiographic images |
214 |
207 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
127 |
120 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
169 |
158 |
$804.86 |
| D1110 |
Prophylaxis - adult |
84 |
77 |
$636.29 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
12 |
$451.74 |
| D1999 |
|
305 |
268 |
$0.00 |
| D0603 |
|
182 |
167 |
$0.00 |